In the Journals

Some opportunistic illnesses still problematic for HIV patients

Although significant strides have been made, research published in The Journal of Infectious Diseases demonstrates that more can be done to treat opportunistic illnesses among HIV patients.

“While recent research suggests that many opportunistic infections in the U.S. are now less common and, oftentimes, less lethal, we cannot forget about them,” Kpandja Djawe, PhD, epidemiologist at the CDC, said in a press release. “We need to keep them in mind, even in the context of the changing epidemiology of HIV.”

Djawe and colleagues studied 20,858 AIDS patients in San Francisco between 1981 and 2012 with at least one AIDS-associated opportunistic illness (AIDS-OI) and categorized them by treatment era: pre-ART (1981-1986; n = 3,002); mono/dual-ART (1987-1996; n = 14,097); and combination ART, or cART (1997-2012; n = 3,759).

According to the study, the top 10 AIDS-OIs diagnosed in these patients from 1981-2012 — pneumocystis pneumonia; Kaposi’s sarcoma; HIV wasting; esophageal candidiasis; Mycobacterium avium complex; HIV encephalopathy; cryptococcosis; cryptosporidiosis; immunoblastic lymphoma; and cytomegalovirus other than retinitis — all saw survivor rate increases between the pre-ART and cART eras 5 years after the AIDS-OIs were diagnosed.

Kpandja Djawe

Overall 5-year survival rates for those with AIDS-OIs increased from 7% during the pre-ART era to 65% in the cART era, the researchers wrote. The AIDS-OI with the greatest survival increase during this period was pneumocystis pneumonia (1% to 69%), while patients with chronic cryptosporidiosis had the best 5-year survival rate (81%) in the cART era.

According to the researchers, the most commonly diagnosed AIDS-OIs were pneumocystis pneumonia (39.1%) and Kaposi’s sarcoma (20.1%). Despite improvements in survival, mortality was still significantly high for AIDS-OIs like brain lymphoma (adjusted HR = 5.14; 95% CI, 2.98-8.87) and progressive multifocal leukoencephalopathy (HR = 4.22; 95% CI, 2.49-7.17).

Sandra Schwarcz

“Early diagnosis, rapid entry into care and initiation of antiretroviral therapy and prophylaxis against opportunistic illnesses (if clinically indicated) are essential to reduce HIV-associated morbidity and mortality,” study researcher Sandra Schwarcz, MD, MPH, associate professor of epidemiology and biostatistics at the University of California, San Francisco, told Infectious Disease News. “Clinicians should counsel patients on the importance of medication adherence, monitor their patients for response to therapy, and be vigilant in diagnosis and treatment of HIV-related and non-HIV-related comorbidities.”

In a related commentary, Henry Masur, MD, chief of the critical care medicine department at the NIH Clinical Center, and Sarah W. Read, MD, director of the therapeutic research program, division of AIDS, NIH, wrote that some AIDS-OIs survival rates remain unimpressive.

“For several opportunistic processes ... such as central nervous system lymphoma and JC virus encephalitis, survival remains especially poor,” they wrote.

“How satisfied should we be that morbidity and mortality resulting from HIV-related opportunistic infections are under control in the United States? ... health care professionals and patients read projections that HIV-infected patients in the United States have the potential to live as long as their HIV-uninfected counterparts if durable HIV suppression is achieved. Unfortunately, however, many geographic areas perform poorly with regards to achieving high rates of durable viral suppression in their HIV-infected populations.” – by David Jwanier

Disclosure: The researchers report no relevant financial disclosures.

Although significant strides have been made, research published in The Journal of Infectious Diseases demonstrates that more can be done to treat opportunistic illnesses among HIV patients.

“While recent research suggests that many opportunistic infections in the U.S. are now less common and, oftentimes, less lethal, we cannot forget about them,” Kpandja Djawe, PhD, epidemiologist at the CDC, said in a press release. “We need to keep them in mind, even in the context of the changing epidemiology of HIV.”

Djawe and colleagues studied 20,858 AIDS patients in San Francisco between 1981 and 2012 with at least one AIDS-associated opportunistic illness (AIDS-OI) and categorized them by treatment era: pre-ART (1981-1986; n = 3,002); mono/dual-ART (1987-1996; n = 14,097); and combination ART, or cART (1997-2012; n = 3,759).

According to the study, the top 10 AIDS-OIs diagnosed in these patients from 1981-2012 — pneumocystis pneumonia; Kaposi’s sarcoma; HIV wasting; esophageal candidiasis; Mycobacterium avium complex; HIV encephalopathy; cryptococcosis; cryptosporidiosis; immunoblastic lymphoma; and cytomegalovirus other than retinitis — all saw survivor rate increases between the pre-ART and cART eras 5 years after the AIDS-OIs were diagnosed.

Kpandja Djawe

Overall 5-year survival rates for those with AIDS-OIs increased from 7% during the pre-ART era to 65% in the cART era, the researchers wrote. The AIDS-OI with the greatest survival increase during this period was pneumocystis pneumonia (1% to 69%), while patients with chronic cryptosporidiosis had the best 5-year survival rate (81%) in the cART era.

According to the researchers, the most commonly diagnosed AIDS-OIs were pneumocystis pneumonia (39.1%) and Kaposi’s sarcoma (20.1%). Despite improvements in survival, mortality was still significantly high for AIDS-OIs like brain lymphoma (adjusted HR = 5.14; 95% CI, 2.98-8.87) and progressive multifocal leukoencephalopathy (HR = 4.22; 95% CI, 2.49-7.17).

Sandra Schwarcz

“Early diagnosis, rapid entry into care and initiation of antiretroviral therapy and prophylaxis against opportunistic illnesses (if clinically indicated) are essential to reduce HIV-associated morbidity and mortality,” study researcher Sandra Schwarcz, MD, MPH, associate professor of epidemiology and biostatistics at the University of California, San Francisco, told Infectious Disease News. “Clinicians should counsel patients on the importance of medication adherence, monitor their patients for response to therapy, and be vigilant in diagnosis and treatment of HIV-related and non-HIV-related comorbidities.”

In a related commentary, Henry Masur, MD, chief of the critical care medicine department at the NIH Clinical Center, and Sarah W. Read, MD, director of the therapeutic research program, division of AIDS, NIH, wrote that some AIDS-OIs survival rates remain unimpressive.

“For several opportunistic processes ... such as central nervous system lymphoma and JC virus encephalitis, survival remains especially poor,” they wrote.

“How satisfied should we be that morbidity and mortality resulting from HIV-related opportunistic infections are under control in the United States? ... health care professionals and patients read projections that HIV-infected patients in the United States have the potential to live as long as their HIV-uninfected counterparts if durable HIV suppression is achieved. Unfortunately, however, many geographic areas perform poorly with regards to achieving high rates of durable viral suppression in their HIV-infected populations.” – by David Jwanier

Disclosure: The researchers report no relevant financial disclosures.